| NPI | 1174112387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIA CORREAL Owener 888-764-5314 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2021-01-12 |